Provider Demographics
NPI:1164880688
Name:GELIN, MELISSA (LAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GELIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1771
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95001-1771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9053 SOQUEL DR
Practice Address - Street 2:SUITE A
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4034
Practice Address - Country:US
Practice Address - Phone:831-239-6141
Practice Address - Fax:831-851-3502
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16894171100000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174H00000XOther Service ProvidersHealth Educator